Membership Form Test Page

* indicates required field

Applicant's Details:

First Name:*

Last Name:*

Date of Birth:*

Gender:*

Male
Female

Address:*

Postcode:*

Home Telephone Number:

Mobile Telephone Number:

Email:*

Medical and Emergency Information:

Emergency Contact Name:*

Relationship to Emergency Contact:*

Emergency Contact Telephone Number:*

Medical Conditions / Allergies:

Membership:

I wish to apply for membership of HINCKLEY RUNNING CLUB and agree to be bound by the rules of the club and the athletic organisations to which the club is affiliated.

Membership Type:*

2019 ANNUAL MEMBERSHIP Affiliated - £40.00 (most popular)
2019 ANNUAL MEMBERSHIP Unaffiliated - £25.00
2019 HALF-YEAR MEMBERSHIP Affiliated ‐ £ 27.50
2019 HALF-YEAR MEMBERSHIP Unaffiliated ‐ £12.50
2019 2nd CLAIM MEMBERSHIP - £15.00

Annual membership runs from 1 January 2019 to 31 December 2019.
For new members joining in November or December of 2018, your membership will run until 31 December 2019 ("14 months for the price of 12").
Half-year membership is only available to new members and runs from 1 July 2019 to 31 December 2019.
Affiliated membership includes HRC membership and England Athletics (EA) individual registration (fee £15.00 for 2019-2020) which enables you to claim a discount at most races (typically £2) as well as other benefits.
Your EA registration will run from 1 April 2019 to 31 March 2020. If you are applying before 1st April and wish to be EA registered immediately, you can choose to pay the additional 2018-2019 EA fee of £15.00.
Unaffiliated membership is for HRC membership only and does not include registration with England Athletics and does not enable you to claim a discount at races.
2nd claim membership is for people who are already EA affiliated members of a different club. If choosing 2nd claim, please state your 1st claim club and EA number below.

Name of 1st Claim Club (if choosing 2nd Claim Membership)

EA Number (if choosing 2nd Claim Membership)

Use of your data

The information you provide on this form will be stored confidentially and will be disclosed only as necessary for Hinckley Running Club activities. This includes: registration with England Athletics (if affiliated membership is chosen); registration for cross country and road league races; a list of names and emergency contacts of club members circulated to committee members and coaches.

You may request to view, update or delete your information at any time by contacting the Membership Secretary.

Use of photographs

Hinckley Running Club sometimes uses photographs taken during club activities to promote the club. For example, in the local news, on the club website (hinckleyrunningclub.com) and on social media. Please indicate whether you are willing for photographs of you to be used in this way.

Use of photographs:*

I consent to the use of photographs of me for publicity purposes
Do not use photographs of me for publicity purposes

Payment:

Payment Method:*

Bank transfer (Sort code: 05-04-65, account no: 47287140)
Cheque (payable to Hinckley Running Club)
Cash
Other

Any further notes or details (if needed):

Please Note:
Your membership will only be valid when it is confirmed that the relevant fee has been paid.
Cheques or cash payments should be given to either Richard Pearson (membership secretary) or Odette Foxall (treasurer).